Course: Diagnostics II Date: 10/10/07 Class #: 3 In the previous classes we talked about the Eight Principles. Now we re moving on to another method of diagnosis, Zangfu syndromes and their associated symptoms. Zangfu syndromes 70% of your job in clinic is Zangfu differentiation. Need to know what pattern, what symptom. There are subtle differences between the deficiencies. There are some key markers and here they are: Palpitations = heart qi deficiency. Cough/short of breath = lung qi deficiency No appetite = spleen qi deficiency Lower back pain = kidney qi deficiency Acupuncture Treatment of Disease Class will address the complicated combinations therein. Page 1 of 8
Heart and Small Intestine Syndromes Heart Patterns Overview Heart and joy/smile/laugh all related. There are a few key symptoms that you need to know for the syndromes... Please exactly make sure! Be able to discuss these: What are the most common symptoms of Heart Disease? Heart Yin Xu Heart Xue(Blood) Xu (common/different)? Heart Fire Flaring Up? Phlegm Fire disturbing Heart? Heart heat transmitting to Small Intestine This is fairly common in the clinic. What the Heart does in Zangfu theory Heart governs Blood. Any kinds of blood heat will disturb heart. Cannot sleep well Control the blood vessels Houses the Mind Heart fire will disturb the Shen. Many kind of mental illness are classified as blood problem. Manifests in the complexion Very red face can indicate heart problems. Joy Heart related to Joy. Overjoy is a problem, not an asset. Opens into the tongue Lots of talking can be related to heart problem. Controls Sweating Pay attention to feel of skin when you shake hands dry skin, cold/wet palm. Too wet = heart disease. Sweaty hands esp when slightly nervous can be related to heart qi s inability to control the fluids. Heart loathes heat Heart fire = insomnia. Dehydration because of high temps/humidity can cause heart disturbance/blood problem/body fluid problems. Differentiation of Heart problems in TCM First, determine deficient or excess Deficiency (Xu) Syndromes Heart Qi Heart Yang Heart Xue (xue = blood) Heart Yin Excess(Shi) Syndromes Heart Fire flaring up Phlegm Fire Disturbing Heart Stagnation of Heart Blood Page 2 of 8
========================================================================= In the symptom charts below, denotes the most important or hallmark symptoms that make the syndrome stand out. Heart Qi Deficiency s Palpitations Shortness of breath, worse with exertion Spontaneous sweating Listlessness Lassitude Tongue: pale with white coat Pulse: thready, weak or irregular The main and most common symptom of heart syndromes Qi deficiency lung can be related. Heart can also be related: zong qi/pectoral qi, which is the central qi of combined heart/lung/food/air qi that resides in the chest helps lung disperse, blood forming (via nutrients) in heart, promotes lung and blood circulation. Any time a symptom is worse on exertion = qi deficiency. Oppression in the chest which is aggrivated by movement is another way to say this. Doesn t refer to night sweats specifically, but plain old spontaneous sweating. Remember that sweat in TCM is Yin/body fluid + Yang/Wei Qi. If Qi and/or Yang are deficient the Yang/Qi cannot close the sweating pores and control sweating. Indicative of Qi deficiency Qi deficiency Indicates Qi or Yang xu Heart Qi deficiency often has abrupt, knotted or intermittent/irregular pulses. The most common symptom grouping for Heart Qi Xu: palpitations, s.o.b., spontaneous sweating, and a pale tongue with a white coat. Heart Yang Deficiency s These are very similar symptoms to those above. Yang Deficiency is a Qi Deficiency + Cold. Without the fire of Yang, the water in the body will not circulate properly, but will gather and sit, causing water retention (edema). Palpitations Shortness of breath, worse on exertion Spontaneous sweating We ve already had this discussion a couple of times refer to Heart Qi Deficiency above if you ve forgotten. Page 3 of 8
Chills Cold limbs Tongue: pale, swollen with a slippery coating Pulse: deep, weak, slow This is definitely different from Heart Qi Defiency, hence the little hand Also unique to Heart Yang deficiency Swollen + slippery coat means the body is more watery and colder due to the yang deficiency. Cold from yang xu (slow), deep because it s been around longer and the condition is chronic, weak due to deficiency. Differences between Heart Qi def and Heart Yang def. Some symptoms are exactly the same: palpitations, s.o.b. worse on exertion and spontaneous sweating for example. Know the differences well however: Differences Heart Qi Def: Pale tongue with white coating, weak pulse Heart Yang Def: Chills Cold limbs Pale, swollen tongue or purplish dark tongue with white slippery coat Deep weak, slow pulse. FYI: What is this? Sudden, profuse cold sweat, cold limbs, feeble respir, pale face, purple lips, unclear mind/coma, pale/purple/watery tongue, feeble pulse. This is a heart yang collapse. (Can be due to severe blood loss.) Heart Blood Deficiency Syndrome Palpitations Insomnia Dream-disturbed sleep Poor memory Pallor/pale face Pale lips Dizziness The main and most common symptom of heart syndromes Normally Qi (yang) nourishes blood (yin) when you are sleeping. If the Blood cannot hold the Qi = insomnia Due to heat in blood disturbing the blood. Dreaming is due to disturbed shen why is it disturbed? 1. Heat or energy is too strong or 2. Blood is too deficienct Short term memory is controlled by the heart, so poor short term memory is the result of a heart blood deficiency and generally comes along with poor concentration. Long term memory, however, is kidney related. Can be caused by Yang, Qi, Blood xu s and/or Cold. While wind can cause dizziness, Blood/Yin xu generates this wind. Malnutrition can cause Blood xu (look for itching with this too). Anemia can cause dizziness as well as vertigo. Page 4 of 8
Vertigo Tongue: pale Pulse: thready/thin, weak See dizziness. And yes, there is a subtle difference between the two. Yin xu is indicated by the thready/thin and weakness is a general deficiency symptom. Heart Yin Deficiency Palpitations Insomnia Dream disturbed sleep Mental restlessness Dryness of mouth Heat sensation in the palms, soles, tidal fever (aka, 5 palm heat) Night sweating Tongue: red with less fluid and less or no coating Pulse: Thready and rapid The main and most common symptom of heart syndromes Heat sign, in this case empty heat Often associated with yin xu. May also have cracking Cheeks will likely be red too Heat signs are the key difference between Heart Yin Deficiency and Heart Blood Deficiency. What they have in common: palpitations, insomnia, dream disturbed sleep What s different about them: Blood xu = pallor, pale lips, dizziness, vertigo, poor mem, pale tongue, thready and weak pulse. Yin xu = mental restlessness, dry mouth, heat sensation in palms/soles, tidal fever, night sweating, red tongue, thready/rapid pulse. Heart Fire Flaring Up s This is an excess condition. The patient will probably also show palpitations, but these were not on Luo s list. Probably not so obvious as the other symptoms. Mental restlessness Insomnia Red face Thirst Ulceration and pain of the mouth and/or tongue Much stronger than that of Heart Yin Xu Severe Not just the cheeks (indicating Yin xu), but the whole face indicating an excess A heat sign Heart opens to the tongue. Fire will flare upwards causing mouth and tongue ulcers as well as painful, swollen tastebuds. (To clear the heart fire, use Dao Chi San formula.) Page 5 of 8
Hot/dark urine, possibly hesitant and/or painful urination Tongue: red Pulse: rapid Hesitation is due to damp heat in the lower jiao. Pain is heat in the lower jiao. Hot/dark urine is a sign of heat You might find the wording like this, but means the same: Irritable, sleeplessness/insomnia, flushed face, thirsty, painful and deep colored frequent urination, red tongue/yellow coat, fast pulse. Irritable indicates not just mental restlessness but liver fire. Phlegm Fire Disturbing the Heart Lots of phlegm in this list as this is a Phlegm Fire pattern. Dr. Luo tells a story of Fan Jing Zhong Ju, the old Chinese man a thousand years ago who finally passed his civil service boards after 50 years of trying and ran through the streets suffering from Overjoy. Someone had to bitch slap him to bring him down to earth. (And that my friends might be why they only let us take the acupuncture boards 3 times!) Delirium Capriciousness Laughter/crying All of these delirium, capriciousness, laughter/crying indicate that the Shen is very disturbed, loose, unrooted. In TCM this grouping is called strange. A strange disease is due mostly to phlegm. Insomnia and restlessness When the Heart Shen is disturbed one cannot fall asleep. This is a heat symptom. Vertigo/dizziness Fever This is a heat symptom. Red face This is a heat symptom. Red eyes This is a heat symptom. Sound of sputum in the throat Phlegm sign duh Yellow sticky sputum with chest Yellow = heat. Sticky = damp/phlegm. Sputum = phlegm. stuffiness Chest stuffiness indicates the Qi can t move due to the phlegm retention disturbing its movement. Tongue: red with yellow/greasy Red = heat. Yellow/greasy = damp, phlegm, heat. coat Pulse: slippery and rapid Slippery indicates damp/phlegm. Rapid indicates heat/fire. Brain exercise Patient has dizziness, heavy feeling in head, suffocating sensation in chest, vomits. What kind of differentiation from the choices below? Excessive liver yang Qi and blood deficiency Page 6 of 8
Stagnated phlegm Kidney essence deficiency Answer: stagnated phlegm. The vomiting is due to the phlegm in the middle jiao, fyi. Heart Blood Stagnation Major difference: purple tongue! Differentiation is called stagnation of heart blood. In biomed speak, this indicates a myocardial infarction. Palpitations Cardiac pain Tongue: purplish with purple spots Pulse: thready, choppy, irregular Major symptom of heart disharmony. Stabbing or stuffy in nature in the precordial region or behind the sternum. Stagnation/stasis pain is prickly/stabbing, fixed in nature, worse at night. (In TCM, when the blood cannot flow freely, there is pain.) If the whole tongue is not purple, there might be purple spots or macula. Remember Dr. Wu s exception to this rule: people of Pakistani origin often have purple looking tongues as a rule and this is not a dysfunction. Choppy due to blood xu, blood stasis or phlegm. Irregular/abrupt pulse is fast, irregularly irregular. Page 7 of 8
Small Intestine Overview Small Intestine does this: Receives and further digests foods from stomach Separates the clear from the turbid Absorbs essential substances and part of the water from foods. Transmits the residue of food to the large intestine and residue of the water to the Bladder. s of Excess Heat in the Small Intestine Pattern: excessive heat transformed from heart to small intestine. Restlessness Thirst Hesitant, scanty and dark urine Burning pain in the urinary tract Bloody urine Tongue: red body with yellow coat Pulse: rapid Too much heat in the blood can break the blood vessels in the urinary tract. Shen disturbances might be evident in this pattern as well. Heat in the SI as well as from the heart hence the shen disturbance. Probably came from heart fire which is transformed downwards to urine/si. Small intestine is related to water metabolism, which is why heat gets transformed to bladder. Why does it go from heart to SI? The two are exteriorly/interiorly related organs. This is very widely seen in the clinic. You can use Dao Chi San can be used to clear the fire. (FYI, I think the chi part of this formula is chi shao, which is powdered hematite stone.) You can also use Heart 8 point. Use LI 11 or St 40 for damp heat or damp heat clearance Page 8 of 8